Provider Demographics
NPI:1659036069
Name:ESPINOZA, VINCENT DANIEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:DANIEL
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TIJERAS AVE NE APT 204
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4484
Mailing Address - Country:US
Mailing Address - Phone:575-208-8596
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3550
Practice Address - Country:US
Practice Address - Phone:505-209-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker